Annual Surveillance Report Of Drug-related Risks And Outcomes
ANNUALSURVEILLANCEREPORT OFDRUG-RELATEDRISKS ANDOUTCOMESUNITED STATES, 2019Centers for DiseaseControl and PreventionNational Center for InjuryPrevention and Control
Annual Surveillance Report of Drug-Related Risks and Outcomes United StatesCDC National Center for Injury Prevention and Control 2019ACKNOWLEDGEMENTSThis Surveillance Report was prepared by staff from the NationalCenter for Injury Prevention and Control (NCIPC), Centers for DiseaseControl and Prevention (CDC), U.S. Department of Health and HumanServices, Atlanta, Georgia.Contributors to this report include: Douglas R. Roehler, PhD, MPH1,Brooke E. Hoots, PhD, MSPH1, Emily O. Olsen, PhD, MSPH1, MbabaziKariisa, PhD1, Nana Otoo Wilson, PhD, MPH, MSc1, Rose A. Rudd,MSPH1, Desiree Mustaquim, MPH1, Likang Xu, MD, MS2, Lyna Schieber,MD, DPhil11Division of Overdose Prevention (DOP), National Center for InjuryPrevention and Control (NCIPC), CDC2Division of Analysis, Research, and Practice Integration (DARPI),National Center for Injury Prevention and Control (NCIPC), CDCCorresponding author: Douglas R. Roehler, droehler@cdc.govThe authors would like to acknowledge Dr. Alana Vivolo-Kantor andDr. Puja Seth for their contributions to the content development andreviews of this report. Thanks to Dr. Lawrence Scholl, Dr. Amy Board,and Mr. Herschel Smith for their editorial and scientific review ofthe report. The authors would also like to acknowledge the NCIPCcommunications team for supporting the development of this reportand accompanying slide deck.This report is based on data collected from multiple sources and isupdated annually. Data on opioid prescriptions filled were obtainedfrom IQVIA Xponent and the Total Patient Tracker (TPT). Dataon drug use, misuse, substance use disorder, and treatment wereobtained from the Substance Abuse and Mental Health ServicesAdministration’s (SAMHSA) 2017 and 2018 National Survey on DrugUse and Health (NSDUH). Data on nonfatal overdose hospitalizationsand emergency department (ED) visits were obtained from theHealthcare Cost and Utilization Project’s (HCUP) National InpatientSample (NIS) and Nationwide Emergency Department Sample (NEDS)2016 surveys, which are sponsored by the Agency for HealthcareResearch and Quality. Data on mortality were obtained from theNational Vital Statistics System’s (NVSS) 2017 mortality files throughCDC WONDER (Wide-ranging Online Data for Epidemiology Research).The report is accessible online at: -drug-surveillance-report.pdf.2DisclaimerThe findings and conclusions inthis report are those of the authorsand do not necessarily representthe views of the Centers for DiseaseControl and Prevention.All materials in this report is in thepublic domain and may be usedand copied without permission butrequires citation.Suggested CitationCenters for Disease Controland Prevention. 2019 AnnualSurveillance Report of Drug-RelatedRisks and Outcomes — UnitedStates Surveillance Special Report.Centers for Disease Control andPrevention, U.S. Departmentof Health and Human Services.Published November 1, 2019.Accessed [date] from -drug-surveillance report.pdf.
TABLE OF CONTENTS7EXECUTIVE SUMMARY11NOTABLE REPORT CHANGES FROM 2018 TO 201913RESULTS OF THE 2019 SURVEILLANCE REPORT13Opioid Prescribing16Drug Use, Misuse, Substance Use Disorder, and Treatment26Nonfatal Overdose Hospitalizations and EmergencyDepartment (ED) Visits34Drug Overdose Mortality40Limitations41CDC’s Opioid Overdose Surveillance and Prevention Efforts45TECHNICAL NOTES56REFERENCES58TABLES59TABLE 1A National estimates of total number and percentage of persons who had at least oneprescription filled for an opioid, by age and sex — United States, 201860TABLE 1B Total number and rate of opioid prescriptions and morphine milligram equivalents(MME) dispensed per 100 persons annually — United States, 201861TABLE 1C Rates of opioid prescriptions filled per 100 persons by type, dosage, and state— UnitedStates, 201862TABLE 1D Trend analyses of opioid prescriptions filled and morphine milligram equivalents (MME)dispensed— United States, 2006-2018
63TABLE 2A Self-reported prevalence of illicit drug use and prescription drug misuse in the pastmonth, persons 12 years old, numbers in thousands — United States, 201767TABLE 2B Self-reported prevalence of illicit drug use and prescription drug misuse in the past year,persons 12 years old, numbers in thousands — United States, 201771TABLE 2C Self-reported prevalence of any prescription drug use (including misuse) in the pastyear, persons 12 years old, by drug type, numbers in thousands — United States, 201772TABLE 2D Self-reported prevalence of past year initiation of illicit drug use and prescription drugmisuse, persons 12 years old, by drug type, numbers in thousands — United States, 201773TABLE 2E Self-reported prevalence of substance use disorder for specific substances in the pastyear, persons 12 years old, numbers in thousands — United States, 201774TABLE 2F Prevalence of self-reported treatment for illicit drug use and prescription drug misusein the past year, persons 12 years old, by demographic characteristics, numbers inthousands — United States, 201775TABLE 2G Self-reported prevalence of illicit drug use and prescription drug misuse in the pastmonth, persons 12 years old, numbers in thousands — United States, 201879TABLE 2H Self-reported prevalence of illicit drug use and prescription drug misuse in the past year,persons 12 years old, numbers in thousands — United States, 201883TABLE 2I Self-reported prevalence of any prescription drug use (including misuse) in the pastyear, persons 12 years old, by drug type, numbers in thousands — United States, 201884TABLE 2J Self-reported prevalence of past year initiation of illicit drug use and prescription drugmisuse, persons 12 years old, by drug type, numbers in thousands — United States, 201885TABLE 2K Self-reported prevalence of substance use disorder for specific substances in the pastyear, persons 12 years old, numbers in thousands — United States, 201886TABLE 2L Prevalence of self-reported treatment for illicit drug use and prescription drug misusein the past year, persons 12 years old, by demographic characteristics, numbers inthousands — United States, 201887TABLE 3A Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated hospitalizations by selected substances, all intents — United States, 201689TABLE 3B Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated hospitalizations by selected substances, unintentional and undeterminedintents — United States, 201691TABLE 3C Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated emergency department visits by selected substances, all intents — UnitedStates, 201693TABLE 3D Estimated numbers and age-adjusted rates per 100,000 population of drug poisoningrelated emergency department visits by selected substances, unintentional andundetermined intents — United States, 201695TABLE 3E Estimated number and percentage of drug poisoning-related hospitalization andemergency department visits by primary payer, all intents — United States, 201697TABLE 3F Estimated number and percentage of drug poisoning-related hospitalization andemergency department visits by primary payer, unintentional and undeterminedintents — United States, 201699TABLE 4A Number and age-adjusted rates per 100,000 population of overall drug overdosedeaths and drug overdose deaths involving any type of opioid, by sex, age group, race/ethnicity, census region, urbanization, and intent — United States, 2017
101TABLE 4B Number and age-adjusted rates per 100,000 population of drug overdose deathsinvolving selected opioids by sex, age group, race/ethnicity, census region,urbanization, and intent — United States, 2017103TABLE 4C Number and age-adjusted rates per 100,000 population of drug overdose deathsinvolving cocaine and other psychostimulants with abuse potential by sex, age group,race/ethnicity, census region, urbanization, and intent — United States, 2017105FIGURES106FIGURE 1ARates for overall annual opioid prescriptions filled per 100 persons and forhigh-dosage prescriptions ( 90 morphine milligram equivalents [MME]/day) —United States, 2006-2018107FIGURE 1BRates for overall annual opioid prescriptions filled per 100 persons by days ofsupply per prescription — United States, 2006-2018108FIGURE 1CAverage daily morphine milligram equivalents (MME) per opioid prescriptiondispensed — United States, 2006-2018109FIGURE 1DAverage days of supply per opioid prescription filled — United States, 2006-2018110FIGURE 2AAge-adjusted rates per 100,000 population of drug overdose deaths and drugoverdose deaths involving any opioid for all intents and for unintentional intentby year — United States, 1999-2017111FIGURE 2BAge-adjusted rates per 100,000 population of drug overdose deaths by drug ordrug class and year — United States, 1999-2017112FIGURE 2CRates per 100,000 population of drug overdose deaths by drug or drug class andage category — United States, 2017113FIGURE 2DAge-adjusted rates per 100,000 population of drug overdose deaths by state —United States, 2017114SUPPLEMENTAL TABLES115SUPPLEMENTAL TABLE 1AOpioid prescriptions filled and morphine milligram equivalents (MME) dispensed—United States, 2006-2018116SUPPLEMENTAL TABLE 2AEstimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-relatedhospitalizations by selected substances, all intents — United States, 2016118SUPPLEMENTAL TABLE 2BEstimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-relatedhospitalizations by selected substances, unintentional and undetermined intents —United States, 2016120SUPPLEMENTAL TABLE 2CEstimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-relatedemergency department visits by selected substances, all intents — United States, 2016
122SUPPLEMENTAL TABLE 2DEstimated numbers and rates (not age-adjusted) per 100,000 of drug poisoning-relatedemergency department visits by selected substances, unintentional and undeterminedintents — United States, 2016124SUPPLEMENTAL TABLE 3ATrend analyses of age-adjusted rates per 100,000 population of drug overdose deathsby drug or drug class—United States, 1999-2017125SUPPLEMENTAL DATA SUPPORTING FIGURE 2AAge-adjusted rates per 100,000 population of drug overdose deaths and drug overdosedeaths involving any opioid for all intents and for unintentional intent by year — UnitedStates, 1999-2017126SUPPLEMENTAL DATA SUPPORTING FIGURE 2BAge-adjusted rates per 100,000 population of drug overdose deaths by drug or drugclass and year — United States, 1999-2017127SUPPLEMENTAL DATA SUPPORTING FIGURE 2CRates per 100,000 population of drug overdose deaths by drug or drug class and agecategory — United States, 2017129SUPPLEMENTAL DATA SUPPORTING FIGURE 2DAge-adjusted rates per 100,000 population of drug overdose deaths by state — UnitedStates, 2017
Annual Surveillance Report of Drug-Related Risks and Outcomes United StatesCDC National Center for Injury Prevention and Control 2019EXECUTIVE SUMMARYThe Current Drug Overdose Epidemic in the United StatesOver 700,000 people died in the United States from drug overdoses between 1999 and 2017, with 70,237deaths in 2017 alone.1 Of these 70,237 deaths, 67.8% involved an opioid.1 The age-adjusted drug overdosedeath rate has significantly increased from 6.0 (1999) to 21.7 (2017) deaths per 100,000 population.2However, as of September 2019, provisional mortality estimates through February 2019 suggest slightdecreases in drug overdose deaths since 2017 in the United States.3The observed increase in opioid overdose deaths can be outlined in three distinct waves. In the 1990s,deaths involving prescription opioids began increasing (Wave 1).4 In 2010, dramatic increases from heroininvolved deaths occurred (Wave 2).5 Finally, since 2013, deaths involving synthetic opioids other thanmethadone (e.g., illicitly manufactured fentanyl) have risen at an unprecedented rate (Wave 3).6-8 From 2016to 2017 alone, synthetic opioid-involved overdose deaths increased by 45.2%.1 More recently, we have seenincreases in overdose deaths involving cocaine (largely with opioids) and psychostimulants with abusepotential (both with and without opioids).9This is the third annual drug surveillance report summarizing the latest data at the national level foropioid prescribing patterns, drug use, nonfatal overdoses, and fatal overdoses related to the currentdrug overdose epidemic in the United States. This report is intended to serve as a resource for 1) peoplecharged with addressing this ongoing national crisis, 2) members of the public who want to stayinformed about the most recently available data, and 3) people who are interested in learning aboutthe current drug overdose landscape and developing innovative and evidence-based solutions toaddress this crisis.This report presents information on four types of outcomes from four different data sources:127Opioid prescribing, 2006-2018, from IQVIA .– This section includes estimates of the total number of opioid prescriptions filled in the United Statesfrom retail pharmacies.Drug use, misuse, substance use disorder, drug initiation, and treatment, 2017 and 2018, from theNational Survey on Drug Use and Health (NSDUH), a survey administered by the Substance Abuse andMental Health Services Administration (SAMHSA).– This section includes estimates of self-reported use of prescription pain relievers, tranquilizers,stimulants, and sedatives in the past month and past year. In addition to prescription use, this sectionincludes self-reported use of marijuana, opioids (heroin use and prescription pain reliever misuse),heroin, cocaine, and methamphetamine in the past month and past year. This section also includesself-reported substance use initiation, disorder, and treatment.
Annual Surveillance Report of Drug-Related Risks and Outcomes United States34CDC National Center for Injury Prevention and Control 2019Nonfatal overdose hospitalizations and emergency department (ED) visits, 2016, from the HealthcareCost and Utilization Project (HCUP), a product of the Agency for Healthcare Research and Quality (AHRQ).– This section includes nonfatal emergency department visits and hospitalizations from poisoningsor overdoses stemming from the following: all drugs, all opioids, heroin, methadone, other specifiedopioids, cocaine, and methamphetamine.Drug overdose mortality, 1999-2017, from the National Vital Statistics System (NVSS) MortalityComponent, maintained by the National Center for Health Statistics (NCHS) at the Centers for DiseaseControl and Prevention (CDC).– This section includes fatalities from drug overdose as the underlying cause of death for the followingdrugs: heroin, natural/semisynthetic opioids (e.g., hydrocodone, oxycodone), methadone, syntheticopioids other than methadone (e.g., fentanyl, tramadol), any opioids, cocaine, and psychostimulantswith abuse potential (e.g., methamphetamine, dextroamphetamine).Opioid PrescribingThe rate of opioid prescriptions filled decreased by 29.0% from 2006 to 2018. In 2006, 72.4 opioidprescriptions per 100 persons were filled, and this rate increased annually by 1.9% from 2006 to 2012 (81.2opioid prescriptions per 100 persons), then decreased by 5.2% annually from 2012 to 2016. Starting in2016, this rate fell more sharply and decreased by 12.4% annually from 2016 to 2018. In 2018, 51.4 opioidprescriptions per 100 persons were filled.In 2018, 15.0% of the U.S. population filled one or more opioid prescriptions. In 2018, 12.8% of males and17.2% of females filled at least one prescription for an opioid.Between 2006 and 2018, the annual rate for filling high dosage opioid prescriptions ( 90 morphinemilligram equivalents [MME]/day) decreased from 11.5 to 3.9 prescriptions per 100 persons, an overallrelative reduction of 66.1%.Drug Use, Misuse, and Substance Use Disorder, and TreatmentIn 2018, over 53 million people aged 12 years and older in the United States, or 19.4% of people aged 12years and older, reported use of illicit drugs or misuse of prescription drugs in the past year. This estimateincludes use of marijuana, heroin, cocaine (including crack), methamphetamines, hallucinogens, inhalants,and the misuse of prescription drugs. Among people aged 12 years and older in the United States, theestimated prevalence of illicit drug use in the past year was 15.9% for marijuana, 0.3% for heroin, 2.0% forcocaine, and 0.7% for methamphetamines. Given the small reported estimated prevalence and burden forhallucinogens and inhalant use, these estimates are not individually reported in this surveillance report butare included in the total estimates. Estimated prevalence of prescription drug misuse by drug type in thepast year was 3.6% for prescription pain, 1.9% for prescription stimulants, 2.1% for prescription tranquilizers,0.4% for prescription sedatives, and 2.0% for prescription benzodiazepines. Reported prevalence of opioidmisuse (i.e., heroin use or prescription pain reliever misuse) in the past year was 3.7%.In 2018, nearly 2.1 million people in the United States reported that they had received treatment in the pastyear to reduce or stop illicit drug use, including prescription drug misuse, or for medical problems associatedwith illicit drug use.Nonfatal Overdose Hospitalizations and Emergency Department (ED) VisitsAn estimated 326,200 hospitalizations for nonfatal drug poisonings, all intents (including unintentional,undetermined intent, and those attributed to intentional self-harm and assault), occurred in 2016, with anage-adjusted rate of 98.1 hospitalizations per 100,000 population. Age-adjusted rates of hospitalizations per100,000 population by drug type for all intents were 26.6 for all opioid poisonings, 7.0 for heroin poisonings,8
Annual Surveillance Report of Drug-Related Risks and Outcomes United StatesCDC National Center for Injury Prevention and Control 20191.6 for methadone poisonings, 18.4 for other opioid poisonings, 6.1 for cocaine poisonings, and 5.7 formethamphetamine poisonings.An estimated 577,794 ED visits occurred for all nonfatal drug-related poisonings, all intents, in the UnitedStates in 2016, with an age-adjusted rate of 183.2 visits per 100,000 population. Age-adjusted rates of EDvisits per 100,000 population by drug type for all intents were 62.0 for all opioid poisonings, 39.1 for heroinpoisonings, 1.0 for methadone poisonings, 22.1 for other opioids poisonings, 2.7 for cocaine poisonings, and5.3 for methamphetamine poisonings.By region, the West had the highest rates of both hospitalizations and ED visits among all intents formethamphetamine-related poisonings.Drug Overdose MortalityA total of 70,237 drug overdose deaths occurred in 2017: an age-adjusted rate of 21.7 per 100,000 persons.Prescription and/or illicit opioids were involved in 67.8% (47,600) of these deaths. Among opioid-involveddeaths, the category synthetic opioids other than methadone (a category that includes illicitly manufacturedfentanyl) was the most common (28,466 deaths). The prescription opioids category, which includes naturaland semi-synthetic opioids (e.g., oxycodone and hydrocodone) and methadone, was the second mostcommon with 17,029 deaths. Heroin was involved in 15,482 deaths. Natural and semi-synthetic opioids wereinvolved in 14,495 deaths, and methadone was involved in 3,194 deaths. Cocaine was involved in 13,942deaths, and 10,333 persons died from drug overdoses involving psychostimulants with abuse potential (e.g.,methamphetamine). Some deaths involved more than one type of drug; these deaths were included in thecounts and rates for each drug category. Therefore, categories are not mutually exclusive.The rapid increase in deaths involving heroin that bega
TABLE 2A Self-reported prevalence of illicit drug use and prescription drug misuse in the past month, persons 12 years old, numbers in thousands — United States, 2017 . 67 . TABLE 2B Self-reported prevalence of illicit drug use and prescription drug misuse in the past year, persons 12 years old, numbers in thousands — United States, 2017 . 71
1.2. Indicator-Based Surveillance (IBS) and Event-Based Surveillance (EBS) Approaches Used to Detect Diseases, Conditions and Events 52 1.3. Standard Case Definitions 52 1.4 Establish Event-Based Surveillance (EBS) at all levels 57 1.5 Update LGA Procedures for Surveillance and Response 58 1.6 Role of the laboratory in surveillance and response 61
Electronic Integrated Disease Surveillance System supports different types of surveillance: passive surveillance (case-based and aggregate) is available for human and veterinary diseases, active surveillance is supported for veterinary disease, vector surveillance is planned to be released in the next version.
member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.
Network: Surveillance of Drug Abuse Trends in the State of Ohio: July - December 2021. Columbus, OH: State of Ohio. Surveillance of Drug Abuse Trends in the State of Ohio. July - December 2021. Prepared by: R. Thomas Sherba,PhD, MPH, LPCC — OSAM Principal Investigator Julia Dionne, MPA, MPH — OSAM Coordinator
Network (NHSN) NHSN is an internet‐based surveillance system that integrates the surveillance systems previously managed separately in the Division of Healthcare Quality Promotion (DHQP) at CDC –National Nosocomial Infections Surveillance (NNIS) system –Dialysis Surveillance Network (DSN)
“In-plan” surveillance means that the facility has committed to following the NHSN surveillance protocol, in its entirety, for that particular event, as shown in the facility’s NHSN monthly reporting plan. “Off -plan” surveillance is surveillance that is done because a facility has decided to track a particular event for internal use.
followed by a response when required. It is this element of decision and timely response based on . endemic and non -infectious diseases under surveillance. Surveillance in Human and Animal Public Health Sectors, and Integrated Surveillance The term 'surveillance' is used differently in veterinary and human public health literature, and .
INTRODUCTION The Discipline and Practice of Qualitative Research Norman K. Denzin and Yvonna S. Lincoln T he global community of qualitative researchers is mid-way between two extremes, searching for a new middle, moving in several different directions at the same time.1 Mixed methodologies and calls for scientifically based research, on the one side, renewed calls for social justice inquiry .
